Treatment of tic douloureux (trifacial or trigeminal neuralgia) abroad
Trifacial neuralgia is a condition that is characterized by the recurrent short episodes of intense pain in the innervation area in one or more branches of the trigeminal nerve.
It is a chronic disease that usually affects people over the age of 50. It is more commonly experienced by women than by men. The overall incidence make up 3-4 cases per 100,000 of population per year.
Causes of Tic douloureux (Trigeminal neuralgia)
Trigeminal neuralgia may be idiopathic (of unknown origin) or symptomatic. Idiopathic neuralgia is commonly seen among the elderly people.
Although the cause of this phenomenon is not individually determined, it is known that the majority of patients who suffer from this condition- it is caused by compression of the nerve root either by enhanced or extended blood vessel.
Causes of symptomatic trigeminal neuralgia:
- Aneurysm or arteriovenous malformations of cerebral vessels
- Some dental diseases
- Traumatic brain injuries
- Inflammatory diseases of the paranasal sinuses
- Systemic vasculitis and diffuse connective tissue diseases
- Multiple sclerosis
Trigeminal neuralgia may be temporary (with acute pathologies). In this case, it goes away after treatment of the underlying disease.
However, most patients have chronic pain in the innervations of the trigeminal nerve area. Without treatment it constantly bothers the patient, significantly reducing the quality of his life.
Tic douloureux (Trigeminal neuralgia) - Symptoms
Trifacial neuralgia is expressed in short, but intensive pain bouts in the area of its innervations. The most frequent places of idiopathic neuralgia localization (95% of cases) are:
- Area of innervations of the maxillary nerve (upper jaw, cheek bones, upper jaw teeth)
- Area of innervations of the mandibular nerve (lower jaw and teeth of the lower jaw)
These are the second and third branches of the trigeminal nerve. Pain in the innervations zone of the first branch (5% of the cases) is more frequent for symptomatic neuralgia. Painful sensations are localized mainly in the forehead and eyes areas.
The duration of the seizures is usually several seconds, though they can last up to several minutes. Patients describe them as “backache” or “shooting” character of pain. The number of the episodes can reach 100 times in twenty-four hours and more.
Because of severe pain patients often shudder. This symptom is called “painful tic”. Pain comes suddenly or under the influence of provocative factors:
Painfulness of some areas is observed when touched. They are called “trigger spots” and located in the nose, cheeks and gums areas.
The clinical picture of symptomatic neuralgia has some peculiarities. In this case, the interictal soreness can remain. There may be a one-sided numbness of the lower lip and chin, reduced sensitivity of the face, weakness of the masticatory muscles and other focal neurological symptoms.
Tic douloureux (Trigeminal neuralgia) - Diagnostics
Trifacial neuralgia is diagnosed on the basis of the clinical manifestations of the disease. A diagnosis is confirmed if four of five criteria given below and determined by the International Headache Society are present:
- Pain in the trigeminal nerve branches innervations areas
- Pain episodes are always identical for an individual case
- Sudden pain, sharp, like an electric shock; it is caused by mechanical irritation of the face, chewing, or a reduction of facial muscles
- Pain decreases after the carbamazepine intake
- Absence of pain in the interictal period
Instrumental methods help with diagnostics, which are necessary for the pathology reasons identification:
- MRI (magnetic resonance imaging) helps to detect the brain tumours, multiple sclerosis and other neurological diseases. An MRI scan is able to detect the proximity of the blood vessel to the branches of the trigeminal nerve. It is found among approximately 85% of patients.
- CT (computed tomography) is a less expensive as well as less informative alternative to MRI.
- Electroneurogram determines the speed of impulses along nerves. It identifies the demyelination of the trigeminal nerve (the degradation of the myelin sheath in the place of contact with the blood vessel).
If the symptomatic trigeminal neuralgia is suspected, a number of other laboratory and instrumental researches can be performed and their choice depends on the main disease.
Treatment of Tic douloureux (Trigeminal neuralgia) abroad
In case of secondary (symptomatic) trigeminal neuralgia the basic disease therapy is required. Treatment of primary trigeminal neuralgia requires conservative or surgical methods.
Chronic Medication is used to treat the majority of patients. After the main therapeutic effect is reached the doses are reduced up to the supportive that is taken by the patient lifelong. Eventually, an addiction may develop and the dose might be increased again. If a person refuses the treatment, the pain occurs again with time.
Physical therapy and reflexology are onlyadditional methods that provide a temporary and poorly expressed effect.
Intraosseous blockade is used in case of the ineffectiveness of drug therapy. Anaesthetics are introduced into the skull bone. Several of these procedures can reduce the severity of pain for some patients for a period of 1 to 6 months.
Microvascular decompression is a neurosurgical operation. It is used in case of the primary (idiopathic) neuralgia. The essence of the operation is to relieve the abnormal compression in the branches of the trigeminal nerve and the adjacent blood vessel. Basically it is the front or posterior inferior cerebella artery, basilar or vertebral artery. Between vessels and nerves is set a protector. The operation causes the throbbing artery to cease irritating the nerve and neuralgia symptoms go away.
Tic douloureux (Trigeminal neuralgia) - Prognosis
Conservative therapy is effective for 75% of cases in case of primary (idiopathic) trigeminal neuralgia. If the effect is not visible then the surgery is required.
Microvascular decompression helps to eliminate the chronic pain syndrome for almost all patients without any accompanying neurological pathology. A year after surgery the effect remains among 95% of operated patients.
One of the reasons of the pain syndrome recurrence can be a dislocated protector placed during the surgery that divides an artery and one of the branches of the trigenial nerve.